Updated at 8.44pm, Aug 24th 2017
DAVE HANCOCK ISN’T surprised.
“First of all, Zlatan is an outstanding professional,” he says.
“That’s what I’ve always heard about him. I don’t know him personally but in the world of football you hear he’s a workaholic, a perfectionist so when you put all of that together as an athlete, you have a lot of attention to detail and so this can really aid an individual’s rehabilitation.”
Hancock was previously head physiotherapist with Leeds, Chelsea and England before moving to the United States and taking up a position as Director of Training and Performance with New York Knicks of the NBA.
Since late-2015, he’s been working with Major League Baseball side the Washington Nationals.
Recovery from cruciate ligament injuries is of particular interest to him.
In 2012, he co-authored a detailed paper on the topic for the Journal of Orthopaedic & Sports Physical Therapy.
He acknowledges that Ibrahimovic’s scheduled return is ‘phenomenal’ but is keen to delve into how and why the Swedish striker’s rehabilitation has gone so well.
“I’ve seen it in other athletes who have come back from long-term injuries,” he tells The42.
“I remember David Batty had an horrendous injury at Leeds United when I was there. It was potentially career-threatening where he had ruptured his Achilles tendon and then it was discovered at surgery that he needed a graft full reconstruction because they were unable to suture the tendon back together, as would be the norm in most Achilles rupture surgeries.
But, he just got to work, did seven or eight hours of rehab a day and managed to save his career and get back to play in the Champions League that season.
In Zlatan’s case, normally when you get older your muscles and tendons get weaker and your body is more susceptible to injury. We know that. It’s scientific fact. So, he’s gone against the norm. But there are other factors. He saw probably one of the best orthopaedic/arthroscopic surgeons in the world in Pittsburgh. He’s world-renowned. And that stuff helps.”
Freddie Fu was the man responsible for performing the surgery on Ibrahimovic’s knee. Since his very first operation in 1981, Fu – who moved to the US from Hong Kong to attend university in the 1970s – has racked up 20,000 of them. And 6,000 of those have been ACL-related.
Based at the University of Pittsburgh’s Medical Centre, Fu is chairman of the department of orthopaedic surgery.
Speaking to the South China Morning News back in May, Fu revealed he had been immensely impressed by Ibrahimovic’s physical conditioning and predicted he’d play on for a number of years yet.
“He’s one of the top athletes I’ve ever touched,” he said.
“He’s in superb shape in all things. Healthy morphology, the quality of the bone and muscle, everything is as good as you can possibly see.
“He can still play for many years, he’s so healthy, so strong biologically, bone morphology, everything, is absolutely very healthy.”
Hancock is quick to praise Manchester United’s medical team, who ensured Ibrahimovic was treated by the very best.
“I can tell you from working in the United States for the last nine years that Freddie Fu is undoubtedly one of the best knee surgeons in the world and he’s respected by his fellow surgeons not just within the US but in the UK too,” he says.
So Manchester United have obviously done their homework and sent him to the best. Based on what the media have said about his recovery, their medical department and Zlatan’s personal physio should be commended for what they’ve done. They’ve been incredible. You’ve got a great surgeon, a great professional athlete, a great medical team – all of that leads to success.”
For four to six weeks following surgery, an athlete will build the knee up through various exercises. The earliest stage of rehab is about controlling the pain and swelling and improving the range of motion. The exercises are basic and monotonous but necessary.
The second stage sees more stress and strain placed on the knee – training on uneven surfaces, using different footwear and in various environments. The football is used in as many drills as possible while there’s a focus on knee stabilisation and resistance. The athlete is allowed on a bike and takes on more physical demands in the pool.
Three-to-five months into rehab, drill work becomes more complex, though increased demand on the knee needs to be carefully managed. Controlled contact is encouraged. Examples of exercises for this time-frame include single-leg hopping – a video of which Ibrahimovic uploaded to social media over two weeks ago.
Then, everything is geared towards returning to play.
With talk of an October comeback, it seems Ibrahimovic is pinpointing playing for United again seven months after suffering the cruciate injury.
Looking at the finer details, is that too soon?
“Every individual is very, very different,” Hancock says.
“It’s phenomenal what he’s done so far. I don’t know where he’s at in terms of recovery but you would normally say – for anyone returning to play from a cruciate – it’s between six months and nine months. Most organisations would err on the side of caution and probably go more toward nine months.
The latter stages of the rehab of a footballer involves a lot of contact. Can he take tackles? Can he move off a mark? Can he shuffle and rotate quickly? It’s the rotation, pivoting, reaction, jumping and the contact that he’ll be doing. Sometimes the contact part of it isn’t always included in some rehab protocols. They wait until they actually get back doing their sport. But I’m pretty sure Manchester United are covering all bases 100%. It looks like they’ve covered a lot of them already.
The press is obviously saying ‘he’s back’. But we don’t know when he’s back or when he’s going to play. So you’ve still got all that to consider. The light is still not at the end of the tunnel. He’s obviously got quite a way to go and time will tell. And it boils down to the athlete. From what I understand, he was a great athlete before he did his cruciate which massively helps. He was very fit before he got this injury. He clearly looks after himself both from a nutritional point of view and a fitness point of view. That all helps in healing. He’s very precise – a lot of modern athletes are – and it’s a possible contributing factor in terms of the recovery process.”
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